Non-invasive Ventilation in Chronic obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is chronic progressive airway disorder characterized by irreversible or fixed airflow limitation.1 Interspersed in the chronic downhill course are episodes of acute flare ups of inflammation, mostly due to infections, termed as acute exacerbations of COPD (AECOPD).2 COPD is a major health problem and one of the leading causes of mortality and morbidity among the middle aged and elderly people both in developed and developing countries. Further, the prevalence of COPD is increasing3 and is projected to rank number three amongst all the causes of loss of DALYS (disability adjusted life years) in India by the year 2020. During the year 2000, approximately 24 million adults in United States had evidence of obstructive airway disease and it was one of the ten leading causes of death.4 COPD was responsible for 1.5 million emergency department visits, 726,000 hospitalizations, and 119,000 deaths.5 Obviously, COPD puts an enormous economic burden and this is true especially for the exacerbations. Andersson and coworkers estimated that almost 35-45 % of the total per capita health-care costs for COPD are accounted for by exacerbations alone.6 Severe exacerbations of COPD frequently require endotracheal intubation and positive pressure ventilation7 Endotracheal intubation is associated with several complications which include barotraumas, tracheal injury, ventilator associated pneumonia and others. Furthermore, patients with AECOPD as compared to other causes of acute respiratory failure tend to have higher rates of ventilator dependence, weaning failures, as well as reintubation.8 Noninvasive ventilation is a mode of giving positive pressure ventilation without endotracheal intubation. Instead of endotracheal tube a mask (Full face or nasal mask) is used for transmission of positive pressure. Following are actions of NIV: • Improved transpulmonary pressure • Inflation of lungs • Assists alveolar ventilation • Reduces muscle fatigue • Improves respiratory muscle compliance • Prevents nocturnal hypoventilation Non-invasive ventilation have several advantages as compared to conventional mechanical ventilation. These include: • Maintenance of oral patenc